Best Practices: Infection Control

Imagine a world where bacteria are now mutating into organisms resistant to most, and in some cases all, of the known antibiotics. Bloodborne pathogens exist which can kill a human being, albeit slowly, after a single exposure if delivery occurs in a fashion that successfully inoculates the host. Mosquitoes and now birds can transmit viruses which can lead to encephalitis and death after a single exposure as well. Bacteria, viruses and toxins can even be used as agents of warfare. Welcome to the 21st century. This is the world in which we live.

If you think that because you are a prehospital health care provider you may be immune to the effects of public health threats, you are mistaken. In fact, you may contribute to the problem because of failure to follow a few basic principles of infection control. The term infection control refers to policies and procedures that minimize the risk of transmission of infectious disease agents from environment to person, person to person, person to the environment and animal to person. Our greatest weapon against the spread of infectious disease is education. Here is some education that you can put into practice on the ambulance five minutes after reading this column.

There was an article published in the British Emergency Medicine Journal several years ago which examined how often significantly dangerous bacteria are harbored in the ambulance and how likely it is that standard cleaning techniques actually eliminate the bacteria.1 Surprisingly, several varieties of potent bacteria, including methicillin-resistant staph aureus (MRSA), were found in the ambulance. The authors found that standard cleaning techniques and solutions were ineffective against significant pathogens including MRSA. In fact, some areas of the ambulance which had been clean initially became secondarily contaminated through poor cleaning methods. Sounds like a hazmat gone bad! While the authors do not provide an exact answer to the question of how to properly clean the ambulance, they make it painfully clear that more research needs to be performed on this topic.

If you spend at least 30 minutes in any emergency department in the United States today, you will witness two important lessons in infection control for EMS providers. Unless an immediately life threatening situation or a disaster occurs, a new patient is never placed on an emergency department stretcher without the Environmental Services personnel first cleaning the entire patient care area or room. This process involves thoroughly cleaning the stretcher by scrubbing it with disinfectant solution, emptying the trash can if it is overflowing, cleaning all work surfaces, disposing of any trash or used medical supplies not in the can and cleaning the walls and floor, if indicated.

It is my personal experience that this degree of decontamination is almost never implemented in the ambulance unless there is a resuscitation. Thus, we create the potential for transmission of infectious particles every time the litter mattress, handrails, seatbelts, blood pressure cuff, pulse oximeter probe (if nondisposable) and a variety of other devices and items are not cleaned prior to their next use. The risk of transmission of bloodborne pathogens is the primary reason why our industry switched from wooden backboards to plastic and from multi-use CIDs to single use devices. How many folks remember what it was like to try to scrub a wooden backboard in order to get the blood off that seeped into the cracks?